The purpose of this K23 Award application is to develop a didactic and research program that will enable Dr. Kopycka-Kedzierawski to become an independent investigator in clinical dental research. The Candidate has a strong interest in the prevention of oral disease, especially dental caries, in underprivileged children. Although an increasing proportion of children are caries free, dental caries remains a significant national public health problem. The impact of oral disease on children is substantial and can lead to much pain and suffering. In the proposed research project, the Candidate will explore Teledentistry, a novel approach that uses an intraoral camera to image teeth and tooth surfaces. Teledentistry has the potential to enhance early diagnosis, access to care and may reduce oral disease burdens, especially in preschool children. In this proposal, Teledentistry is defined as the use of dental information exchanged from one site to another via electronic communications to improve oral health. To determine if Teledentistry is useful in reducing oral disease burden in preschool inner city children, an intervention study will be conducted in selected inner city childcare centers that are participating in Health-e-Access, a Telemedicine project conducted by the candidate's co-mentor, Kenneth McConnochie, MD, MPH. Our plan is to recruit 520 children, 12 to 48 months of age. Eligible children will be randomized into two groups: group one will receive a traditional visual/tactile oral examination and group two will receive a Teledentistry examination. Teledentistry data will be transmitted to a remote site for interpretation by a dentist and referral for dental care, as needed. The specific aims of this proposal are: 1. a) To assess dental care utilization patterns among children receiving an examination by means of Teledentistry compared to children receiving a traditional visual/tactile oral examination;b) To build a prognostic factor model for utilization of dental care, c) To determine the level of satisfaction and acceptance of Teledentistry examinations among parents of children examined by means of Teledentistry. 2. a) Based on empirical data obtained from the intervention study, estimate the cost-effectiveness of Teledentistry compared to a traditional visual/tactile oral examination;b) Develop a hypothetical Markov model to estimate the cost-effectiveness of Teledentistry compared to a traditional visual/tactile oral examination. Our broad long-term objective is to explore the full range of Teledentistry to reduce oral disease burden and to enhance dental care utilization in childcare centers and schools, especially in inner city and rural areas. We are optimistic that Teledentistry will greatly enhance our ability to identify children with dental disease or who are at high risk of dental disease, at an earlier stage. Teledentistry has the potential to be a significant new resource for enhancing early diagnosis and referral for treatment of children who otherwise might not receive care in a timely manner.